COVID-19

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Open access

Jared S. Rosenblum, Jessa M. Tunacao, Matthew A. Nazari, Halle Ronk, Danielle D. Dang, Chad Downing, Zhengping Zhuang, John D. Heiss, James G. Smirniotopoulos, Avraham Bluestone, James Badia, and Joseph White

BACKGROUND

Reports of cerebrovascular ischemia and stroke occurring as predominant neurological sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which causes coronavirus disease 2019 (COVID-19), are increasingly evident within the literature. While various pathophysiological mechanisms have been postulated, including hypercoagulability, endothelial invasion, and systemic inflammation, discrete mechanisms for viral neurotropism remain unclear and controversial.

OBSERVATIONS

The authors present a unique case study of a 64-year-old male with acute COVID-19 infection and acute worsening of previously stable cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), a rare heritable arteriopathy due to mutation in the Notch3 gene, which is critical for vascular development and tone. Delayed cranial neuropathies, brainstem fluid-attenuated inversion recovery signal, and enhancement of olfactory and vagus nerves on magnetic resonance neurography in this patient further support viral neurotropism via cranial nerves in addition to cerebral vasculature.

LESSONS

To the authors’ knowledge, this is the first case in the literature that not only demonstrates the consequences of COVID-19 infection in a patient with altered cerebrovascular autoregulation such as CADASIL but also highlights the tropism of SARS-CoV-2 for (1) cranial nerves as a mode of entry to the central nervous system and (2) vessels as a cause of cerebrovascular ischemia.

Open access

Ezek Mathew, Julie Williamson, Lois Mamo, and Rob Dickerman

BACKGROUND

Transverse myelitis is a rare neurological occurrence with varied presentation. Imaging is necessary to properly diagnose this condition; however, identifying the cause of this condition may often be difficult.

OBSERVATIONS

An otherwise healthy patient presented to the clinic with peculiar neurological symptoms without an obvious underlying cause. Imaging evidenced no significant structural defects but did lead to discovery of cord enhancement compatible with a diagnosis of transverse myelitis. Corticosteroid treatment was initiated rapidly to address this pathology, and the patient recovered without deficits. To identify the underlying cause, patient medical history was reviewed thoroughly and compared with existing literature. Previous tuberculosis infection could be a less likely cause of the neurological symptoms. However, recent vaccination with the Johnson & Johnson coronavirus disease 2019 (COVID-19) vaccine could be a more likely cause of the transverse myelitis, which has been rarely reported.

LESSONS

Transverse myelitis after COVID-19 infection has been an escalating phenomenon. However, transverse myelitis after COVID-19 vaccination is a rare occurrence that is also on the rise. Given the increased rates of vaccination, transverse myelitis should not be overlooked as a potential pathology, due to the severity of neurological impairment if this condition is not treated rapidly.

Open access

Kern H. Guppy, Yekaterina K. Axelrod, and Han Kim

BACKGROUND

Bilateral papilledema with vision loss is considered a neurosurgical emergency due to high intracranial pressure. However, it may not be the only cause of papilledema. The authors reported an association among coronavirus disease 2019 (COVID-19), bilateral papilledema, blindness, and Wernicke’s encephalopathy (WE).

OBSERVATIONS

An 18-year-old woman presented to the neurosurgery service with rapid profound vision loss and bilateral papilledema. She had COVID-19 3 months earlier with subsequent loss of smell (anosmia) and taste (ageusia), which resulted in hyperemesis and a 43-lb weight loss. Examination revealed ataxia, horizontal nystagmus, and blindness. Magnetic resonance imaging and magnetic resonance venography of her brain were normal. Presumptive diagnosis of WE was made, and she was treated with intravenous thiamine with restoration of vision within 48 hours. Patient’s thiamine level was less than half the normal value.

LESSONS

Neurosurgeons should be aware of this unique correlation between papilledema and vision loss and its association with WE due to post–COVID-19 hyperemesis and weight loss from anosmia and ageusia.

Open access

Eric K. H. Chow, Barry M. Rabin, and John Ruge

BACKGROUND

Conditions that can mimic posterior fossa tumors are rare. Their identification is crucial to avoid unnecessary surgical intervention, especially when prompt initiation of medical therapy is critical.

OBSERVATIONS

The authors presented a case of pseudotumoral hemorrhagic cerebellitis in a 3-year-old boy who presented initially with headache, persistent vomiting, and decreased level of consciousness 9 weeks after severe acute respiratory syndrome coronavirus 2 infection. Magnetic resonance imaging showed a left cerebellar hemorrhagic mass–like lesion with edema and mild hydrocephalus. The patient responded to high-dose steroids and was discharged 2 weeks later with complete recovery.

LESSONS

When evaluating patients with possible tumor syndromes, it is important to also consider rarer inflammatory syndromes that can masquerade as neoplasms. Postinfectious hemorrhagic cerebellitis is one such syndrome.

Restricted access

Virendra R. Desai, Audrey Grossen, Huy Gia Vuong, Nicholas Hopkins, Mikayla Peters, and Andrew Jea

OBJECTIVE

COVID-19 has not only impacted healthcare systems directly via hospitalizations and resource utilization, but also indirectly via adaptations in healthcare practice, such as the evolution of the academic environment and the rise of telemedicine and virtual education. This void in clinical responsibilities has been filled with academic productivity in various fields. In this study the authors investigate the influence of COVID-19 on the academic focus within pediatric neurosurgery.

METHODS

All data were obtained from the Journal of Neurosurgery: Pediatrics (JNS Peds). The number of submissions for each month from January 2017 to December 2021 was collected. Data including number of publications, publication level of evidence (LOE), and COVID-19–related articles were collected and verified. Each publication was categorized by manuscript and LOE according to adaptations from the Canadian Task Force on Periodic Health Examination. Publication groups were categorized as pre–COVID-19 (January 2017–February 2020), peri–COVID-19 (March 2020–July 2020), and post–COVID-19 (August 2020–December 2021). Statistical analysis was performed to compare pre–COVID-19, peri–COVID-19, and post–COVID-19 academic volume and quality.

RESULTS

During the study time period, a total of 3116 submissions and 997 publications were identified for JNS Peds. Only 2 articles specifically related to COVID-19 and its impact on pediatric neurosurgery were identified, both published in 2021. When analyzing submission volume, a statistically significant increase was seen during the shutdown relative to pre–COVID-19 and post-shutdown time periods, and a significant decrease was seen post-shutdown relative to pre–COVID-19. LOE changed significantly as well. When comparing pre–COVID-19 versus post–COVID-19 articles, a statistically significant increase was identified only in level 4 publications. When analyzing pre–COVID-19 versus post–COVID-19 (2020) and post–COVID-19 (2021), a statistically significant decrease in level 3 and increases in levels 4 and 5 were identified during post–COVID-19 (2020), with a rebound increase in level 3 and a decrease in level 5 during post–COVID-19 (2021).

CONCLUSIONS

There was a significant increase in manuscript submission during the initial pandemic period. However, there was no change during subsequent spikes in COVID-19–related hospitalizations. Coincident with the initial surge in academic productivity, despite steady publication volume, was an inverse decline in quality as assessed by LOE.

Open access

Anand Kumar Das, Suraj Kant Mani, and Saraj Kumar Singh

BACKGROUND

Telemedicine is the use of wireless communications and Web-based technologies to provide healthcare and services. The coronavirus disease 2019 (COVID-19) pandemic has posed an unprecedented challenge to healthcare providers, who have been forced to change their usual mode of service delivery and have been given an opportunity to adopt the concept of telemedicine.

OBSERVATIONS

A 40-year-old underprivileged and unseparated conjoined twin (pygopagus) had dorsal spine tuberculosis and was on a regular follow-up through telemedicine due to the ongoing COVID-19 pandemic and embarrassment they had to face in public appearances. After a few months, they contracted COVID-19 infection after which they were shifted to our tertiary care center. Several unique challenges were encountered during the 4-day course of management. Ultimately, they died and left us with questions of whether we are really prepared to tackle these challenges.

LESSONS

The general public should be made aware of such groups of patients and to encourage them to follow COVID-appropriate behavior. Vaccinations should be given on a priority basis to these subsets. A more robust approach of telemedicine consultation is required for management of patients in remote areas at the time of a pandemic. Ventilator management of these patients is still intriguing.

Free access

Reid A. Johnson, Anne Eaton, Christopher J. Tignanelli, Kailey J. Carrabre, Christina Gerges, George L. Yang, Mark R. Hemmila, Laura B. Ngwenya, James M. Wright, Ann M. Parr, and

OBJECTIVE

The authors’ objective was to investigate the impact of the global COVID-19 pandemic on hospital presentation and process of care for the treatment of traumatic brain injuries (TBIs). Improved understanding of these effects will inform sociopolitical and hospital policies in response to future pandemics.

METHODS

The Michigan Trauma Quality Improvement Program (MTQIP) database, which contains data from 36 level I and II trauma centers in Michigan and Minnesota, was queried to identify patients who sustained TBI on the basis of head/neck Abbreviated Injury Scale (AIS) codes during the periods of March 13 through July 2 of 2017–2019 (pre–COVID-19 period) and March 13, 2020, through July 2, 2020 (COVID-19 period). Analyses were performed to detect differences in incidence, patient characteristics, injury severity, and outcomes.

RESULTS

There was an 18% decrease in the rate of encounters with TBI in the first 8 weeks (March 13 through May 7), followed by a 16% increase during the last 8 weeks (May 8 through July 2), of our COVID-19 period compared with the pre–COVID-19 period. Cumulatively, there was no difference in the rates of encounters with TBI between the COVID-19 and pre–COVID-19 periods. Severity of TBI, as measured with maximum AIS score for the head/neck region and Glasgow Coma Scale score, was also similar between periods. During the COVID-19 period, a greater proportion of patients with TBI presented more than a day after sustaining their injuries (p = 0.046). COVID-19 was also associated with a doubling in the decubitus ulcer rate from 1.0% to 2.1% (p = 0.002) and change in the distribution of discharge status (p = 0.01). Multivariable analysis showed no differences in odds of death/hospice discharge, intensive care unit stay of at least a day, or need for a ventilator for at least a day between the COVID-19 and pre–COVID-19 periods.

CONCLUSIONS

During the early months of the COVID-19 pandemic, the number of patients who presented with TBI was initially lower than in the years 2017–2019 prior to the pandemic. However, there was a subsequent increase in the rate of encounters with TBI, resulting in overall similar rates of TBI between March 13 through July 2 during the COVID-19 period and during the pre–COVID-19 period. The COVID-19 cohort was also associated with negative impacts on time to presentation, rate of decubitus ulcers, and discharge with supervision. Policies in response to future pandemics must consider the resources necessary to care for patients with TBI.

Open access

Amin I. Nohman, Meltem Ivren, Sabrina Klein, Elham Khatamzas, Andreas Unterberg, and Henrik Giese

BACKGROUND

In this case report the authors present two female patients with intracranial mucormycosis after coronavirus disease 2019 (COVID-19).

OBSERVATIONS

The first patient was a 30-year-old woman with no past medical history or allergies who presented with headaches and vomiting. Magnetic resonance imaging (MRI) and computed tomography of the skull showed an endonasal infection, which had already destroyed the frontal skull base and caused a large frontal intracranial abscess. The second patient was a 29-year-old woman with multiple pre-existing conditions, who was initially admitted to the hospital due to a COVID-19 infection and later developed a hemiparesis of the right side. Here, the MRI scan showed an abscess configuration in the left motor cortex. In both cases, rapid therapy was performed by surgical clearance and abscess evacuation followed by antifungal, antidiabetic, and further supportive treatment for several weeks.

LESSONS

Both cases are indicative of a possible correlation of mucormycosis in the setting of severe immunosuppression involved with COVID-19, both iatrogenic with the use of steroids and previous medical history. Furthermore, young and supposedly healthy patients can also be affected by this rare disease.

Open access

Sarah E. Blitz, J. Tanner McMahon, Joshua I. Chalif, Casey A. Jarvis, David J. Segar, Weston T. Northam, Jason A. Chen, Regan W. Bergmark, Jennifer M. Davis, Sigal Yawetz, and Omar Arnaout

BACKGROUND

Hypercoagulability with thrombosis and associated inflammation has been well-documented in COVID-19, and catastrophic cerebral venous sinus thromboses (CVSTs) have been described. Another COVID-19–related complication is bacterial superinfection, including sinusitis. Here, the authors reported three cases of COVID-19–associated sinusitis, meningitis, and CVST and summarized the literature about septic intracranial thrombotic events as a cause of headache and fever in COVID-19.

OBSERVATIONS

The authors described three adolescent patients with no pertinent past medical history and no prior COVID-19 vaccinations who presented with subacute headaches, photosensitivity, nausea, and vomiting after testing positive for COVID-19. Imaging showed subdural collections, CVST, cerebral edema, and severe sinus disease. Two patients had decline in mental status and progression of neurological symptoms. In all three, emergency cranial and sinonasal washouts uncovered pus that grew polymicrobial cultures. After receiving broad-spectrum antimicrobials and various additional treatments, including two of three patients receiving anticoagulation, all patients eventually became neurologically intact with varying ongoing sequelae.

LESSONS

These cases demonstrated similar original presentations among previously healthy adolescents with COVID-19 infections, concurrent sinusitis precipitating CVST, and subdural empyemas. Better recognition and understanding of the multisystem results of severe acute respiratory syndrome coronavirus 2 and the complicated sequelae allows for proper treatment.

Open access

Keisuke Onoda, Ryohei Sashida, Ren Fujiwara, Tomihiro Wakamiya, Yuhei Michiwaki, Tatsuya Tanaka, Kazuaki Shimoji, Eiichi Suehiro, Fumitaka Yamane, Masatou Kawashima, and Akira Matsuno

BACKGROUND

Vaccines against coronavirus disease 2019 have a high level of efficacy and safety across all populations. However, numerous case series have been published on neurological disorders, including Bell’s palsy, Guillain-Barre syndrome, transverse myelitis, and multiple sclerosis. The authors presented a case of trigeminal neuropathy after coronavirus vaccination in a patient who had undergone microvascular decompression (MVD) for trigeminal neuralgia (TN).

OBSERVATIONS

A 77-year-old woman presented with acute trigeminal neuropathy after receiving a Pfizer-BioNtech vaccination (tozinameran) against severe acute respiratory syndrome coronavirus 2. The patient had undergone MVD for TN and the facial pain completely disappeared. One month later, she received the first injection of the tozinameran vaccine. Twelve hours after vaccination, she presented with numbness and pain induced by touching any place on the entire right face. No eruption was observed on her face. The serum herpes zoster virus antibodies were confirmed within the normal range. Magnetic resonance imaging revealed no abnormalities. The authors suspected a right trigeminal neuropathy after vaccination. Administration of carbamazepine and pregabalin improved TN but facial numbness persisted, especially in the mandibular division.

LESSONS

The coronavirus is a possible etiology of secondary trigeminal neuropathy in the case of MVD for TN.